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MBProject Sharpens Aim to C.O.M.B.A.T. Healthcare Costs

The Medical Banking Project announced its first pilot effort – the “HSA Accumulator Use Case” – under its national reference architecture program dubbed “C.O.M.B.A.T.”, short for “Cooperative Open-source Medical Banking Architecture & Technology”. The effort uses advanced banking systems to fight against rising healthcare costs.

The Use Case targets a critical problem in consumer-driven healthcare; namely, on-demand access to how much a patient owes when using a High Deductible Health Plan (HDHP). Because this is often difficult to determine, financial risk by hospitals and physicians under the HDHP formula is expected to increase and this will adversely impact adoption.

“Much like credit card firms authorize payment at the counter, care providers should be able to ascertain what the HDHP patient owes and get paid in real time whenever possible,” said John Casillas, Founder of MBProject. “The issue is troubling employers because they are investing in new consumer-driven plans and want to see them succeed. Accordingly, we’re delighted that Exante Bank and United Healthcare is providing seed funding for this project. Our member banks and financial services firms are also participating to broaden adoption of an open solution.”

The Project organized two national meetings in 2006 (Atlanta/September; Chicago/November) resulting in the organization of workgroups that will meet at the 5th National Medical Banking Institute (March 5-7, 2007 in Marietta, Georgia), open to the public. Registration for the 2-day event is available at http://www.mbproject.org.

“We needed an open forum that could build cross-industry consensus around a hybrid transaction so we turned to MBProject,” said Dean Mason, President of Exante Bank, an operating unit of United Healthcare. The open standard will incorporate seamless transfer of available and/or credited funds from Health Savings Accounts, and will be comprised of existing banking and healthcare standards that incorporate HIPAA and relevant banking requirements.

MBProject asked David Harris, Partner, PricewaterhouseCoopers, to facilitate the development of the business requirements at member sessions. “MBProject offers a consensus-based program to standardize cross-industry data exchanges. Their program is supplemented by extensive and ongoing education,” Harris said. “Facilitating adoption of this transaction is important for building out HSAs and other hybrid solutions in the marketplace.” Harris chairs MBProject’s HSA Workgroup and writes a “Dr. HSA” column for the MBProject website.

MBProject Member ACS sponsored an initial meeting in Atlanta to isolate issues in real time processing. “We bring a real world operating perspective to the table,” said BP Fulmer, Executive Director, Commercial EDI, ACS, “because we do real time adjudication of Medicaid claims in some areas of the country as well as deliver real time eligibility and status reporting – both key components to a solution.” Fulmer is President of the National Medical Banking Institute and heads its President’s Council with leading domain experts in banking and healthcare.

MBProject’s C.O.M.B.A.T. Initiative compiles existing standards and open source components to build out a testing harness and prove a new class of software code called “mbXML”. The program has attracted a growing cadre of global firms like Disney, Sanofi-Aventis, Visa, PNC Bank, McKesson, Wachovia, US Bank, Fifth Third Bank and most recently Sun Microsystems, among others.

“We looked at what they were doing and decided it was ‘Sun-sized’,” said Peter Berkman, Senior Director, Composite Applications and Platforms, Sun Microsystems, a global leader in open standards and information technology. “We joined MBProject because we believe there are opportunities to reduce healthcare costs using the medical banking approach and we’re very pleased to team with the pioneers of this strategy. They are obviously highly committed to making it happen.” Sun will host the C.O.M.B.A.T. platform and has assigned full time resources to build out a new “medical banking ecosystem that is global in nature”.

“Our work is multi-domain and long term in nature,” Casillas said. “When we addressed privacy and security policy in 2001 we believed that a testing platform could demonstrate the efficacy of utilizing banking systems for healthcare. At that time the discussion around the convergence of healthcare and banking was not prevalent and we had to pioneer the dialogue and articulate models that could leverage banks to reduce healthcare costs. Today medical banking discussions are emerging around the globe. Our Members are fully engaged and we’re energized about how new cross-industry innovations in this arena will tackle critical healthcare challenges.”

To learn more about medical banking and the C.O.M.B.A.T. HSA Accumulator Use Case, plan to attend the Fifth National Medical Banking Institute on March 5-7, 2007 at the Marietta Conference Center and Resort in Marietta, Georgia.